The current proposal will attempt to identify whether genitourinary tract infections that are common among HIV(+) U.S. women alter HIV expression in the GU tract, and whether antimicrobial therapy results in decreases in genital tract infections (STDs) have been identified as major potentiators of HIV acquisition and transmission globally. the prevalence of specific STDs varies greatly geographically and the co-prevalence of HIV and specific GU infections has not yet been well-defined among U.S. women. The HIV Epidemiology Research Study (HERS) is a prospective cohort study of 800 HIV(+) and 400 HIV(-) women being recruited in 4 U.S. cities, which will help to delineate the natural history of HIV in American women. This planned proposal is based on previous observations by our group that the detection of HIV in the male GU tract was extremely variable between and within infected men over time. Asymptomatic leukocytospermia was common and not fully explained by HIV-associated immunosuppression or antiretroviral therapy. Among HIV(+) and HIV(-) women studied in the Brown University AIDS Program (BRUNAP), prior to, and now as part, of HERS, varying patterns of GU infection and inflammation have been noted, but have not yet been correlated with GU tract HIV disease or the specific antimicrobial therapy for local infections. The current proposal will examine GU HIV load by quantitative DNA/RNA PCR and monitor GU inflammation by immunohistological exam cross-sectionally in each HIV(+) HERS participant and sequentially determine the HIV PCR load in HIV(+) women who develop one of the following clinical entities: vaginal candidiasis, trichimoniasis, bacterial vaginosis, mucopurulent cervicitis, HPV +/- atypical PAP, or who have idiopathic GU inflammation, and monitor the effect of specific antimicrobial therapy to determine whether treatment decreases GU inflammation (leukocytosis) and HIV load, and whether acute changes in these parameters remain stable over time.